Parenting stress in autism spectrum disorder: A comparative analysis with other developmental disabilities.

Parents of autistic children experience more stress than parents of children with other developmental disabilities. The extra stress mainly comes from child-related challenges like hyperactivity, difficulty adapting to change, and less positive interaction with parents. Interestingly, having an autism diagnosis doesn't directly cause more stress - instead, it's the reduced back-and-forth interaction between child and parent that leads to higher stress levels.

This comparative study examined parenting stress in 48 families with autistic children versus 77 families with children having other developmental disabilities. Parents of autistic children experienced significantly higher overall parenting stress, primarily driven by child-related factors including distractibility/hyperactivity, adaptability challenges, and reduced reinforcement of parental efforts. Importantly, the autism diagnosis itself did not directly cause higher stress levels. Instead, mediation analysis revealed that autism indirectly influenced parenting stress through reduced child-initiated interactions.

High parenting stress was best predicted by poor initiative interaction rather than the autism diagnosis, suggesting that specific behavioral patterns rather than diagnostic labels drive parental stress experiences.

Clinicians should assess parent-child interaction patterns and target initiative interaction skills in interventions. Family support should focus on managing specific behavioral challenges rather than diagnosis alone. Early intervention promoting child-initiated interactions may reduce long-term parenting stress in autism families.

Single-center retrospective design limits generalizability. Relatively small sample size may affect statistical power. Cross-sectional analysis cannot establish temporal relationships between variables. Study limited to Korean population which may not reflect other cultural contexts.

To compare parenting stress between parents of children with autism spectrum disorder (ASD) and other developmental disabilities (DDs) and to examine ASD's influence on parenting stress through mediation analysis. We retrospectively analyzed 48 children with ASD (ASD group) and 77 with non-ASD DDs (non-ASD group), along with one of their parents, at the Gyeongsang National University Hospital between May 2021 and August 2024. All underwent developmental assessments and completed the Korean version of the Parenting Stress Index-4 and the Child Interactive Behavior Test (CIBT). The ASD group's median age was 37.5 months, with 37 boys (77.1 %).

No significant difference was found in child age, sex, or parental demographics between the groups. Total parenting stress was significantly higher in the ASD group (p = 0.01), primarily due to higher child domain scores (p<0.01) than in the non-ASD group. Among the child domain subscales, Distractibility/Hyperactivity, Adaptability, Reinforces Parent, and Acceptability were significantly higher in the ASD group, while only the Attachment subscale differed in the parent domain. For high parenting stress (>85th percentile), Initiative Interaction-a CIBT subscale-was the only independent predictor, rather than ASD diagnosis.

Mediation analysis showed no direct effect of ASD on parenting stress (β = 4.28, p = 0.42) but an indirect effect via reduced initial interaction (β = 3.68, p<0.05). Parenting stress was higher in the ASD group, mainly due to child-related factors. ASD influenced parenting stress indirectly through reduced initiative interaction. These findings provide further insight into parenting stress in families of children with ASD.